In Georgia, LGBTQIA+ advocates make HIV prevention and care available to all

Tbilisi, Georgia – Beka Gavadadze, who works as a social worker for the LGBTQIA+ community in Georgia’s capital, Tbilisi, quickly learned that a person’s gender identity and expression can impact every aspect of their life.

“The problem isn’t just health care. There are housing problems, employment, a lot of violence and many other issues,” he told the United Nations Population Fund (UNFPA).

Gabadadze began his career with UNFPA partner Tanad Goma in 2013, providing sexual and reproductive health information and counselling to LGBTQIA+ people and raising awareness about HIV testing and prevention services.

Georgia is considered a country with a low HIV and AIDS prevalence, with only 0.3% of the adult population estimated to be infected with the virus in 2023. However, the data is different for men who have sex with men, whose infection rate rose from 7% in 2010 to a high level of over 25% in 2015. Among this group, Georgia had the highest HIV infection rate in the Eastern Europe and Central Asia region at the time.

But the data only tells part of the story: The increase is also due to successful awareness campaigns about the importance of testing and care: In Tbilisi, the number of men who have sex with men who have been tested and know their HIV status jumped from just over 15% in 2010 to more than 54% in 2018.

With UNFPA support, Tanadgona organizes referrals to HIV and STD clinics, hosts events to inform LGBTQIA+ people about sexual and reproductive health and rights, and has established numerous community centers in the country’s three largest cities – Batumi, Kutaisi and Tbilisi – as well as smaller towns such as Telavi and Zugdidi.

By 2023, HIV infection rates among gay men are reported to fall to just over 15%, still 26 times higher than the general population. Advocacy efforts have also led to policy advances, with the government prioritizing prevention of new HIV infections among key populations and their sexual partners, and providing free testing services for all. In 2017, Georgia became the first country in the Eastern Europe and Central Asia region to introduce pre-exposure prophylaxis (PrEP) for gay men and transgender people.

Innovative responses to ongoing challenges

But while these programs are expanding, fears of publicly identifying as LGBTQIA+ keep many from attending information sessions or seeking HIV testing and treatment. Even the community centers in Telavi and Zugdidi eventually closed due to opposition from local residents and the high costs of maintaining services in such remote areas.

Since then, new initiatives have emerged. For example, a joint project by UNFPA, the United Nations Development Programme (UNDP) and Tanad Goma provides free sexual health kits that can be ordered anonymously online. The packages include rapid HIV tests, condoms and guidance on STI prevention and health services. “We are tailoring resources and new technologies to the needs of the community,” Gabadadze said.

The latest data from Georgia shows that years of efforts have paid off, with knowledge about HIV improving significantly among target groups in major cities: in 2010, less than a fifth of people surveyed in Tbilisi had adequate knowledge about the virus; by 2018, that number had almost doubled to 37%.

The right to sexual and reproductive health for all

In 2019, Gabadadze joined the UNFPA-supported transgender rights organisation Temida, and was shocked by the stories she heard from the community: “They were being pushed out by their families, they could be bullied, and in many cities it was even difficult for them to access public transport.”

While gender reassignment treatment is legal in Georgia, transgender people still have a long way to go before having equal access to proper medical care. Gavadadze explained that when he started working at Temeda, there was only one endocrinologist in the country who offered hormone therapy, and the treatment was very expensive and not covered by insurance, making it out of reach for most people.

Those who could afford it had to see doctors unfamiliar with treating transgender patients, so Gavadadze and his team trained health workers on the community’s needs, language sensitivity, and combating prejudice and stigma.

“At least there are three practices doing the service now,” he said. “When there was just one doctor, the fees were pretty high, but now they’re starting to come down.”

Protecting fragile progress

Still, Gavadadze knows the work isn’t done, and that things could go back to the way they were. Homophobic and transphobic attitudes remain rife; a 2021 poll found that more than 60% of respondents oppose same-sex marriage and the right of LGBTQIA+ people to adopt children. The Georgian parliament is also considering draft legislation that would ban heterosexual marriage and legal or surgical sex change.

Gavadadze worries that reduced international funding and government support could force LGBTQIA+ people to go underground again to seek medical care, as new, untested hormones and treatments are already emerging through unofficial channels. Instead, he urged the community to rely on their own experiences to prepare for what may come.

“I urge our community to remain prepared,” he said, “Obviously, we have to do things differently, but we are still resilient.”